23 Community pharmacy - part 1
The Community and hospital pharmacy subjects are not being taught the way they should be taught. With due respects and regards to the authors and teachers, I am helpless but to feel that there appears to be an oversimplified understanding of the retail drug industry among the teachers and authors. The main gaps I find in the curriculum, books and teachings are; 1. They are not from the professionals or from people with field experience. 2. Field is having totally a different outlook, ambience and challenges 3. Lots of myths and unfounded issues and doubts are being taught into the young minds 4. More of clinical intervention is emphasized unnecessarily at the cost of ways and means to professionalize the service to support the clinical system 5. Issues that are not of much concern to the pharmacist like CSSD, RUD are given over importance. 6. Actually there is absolutely no role in RUD for community pharmacist. The CSSD is the nurses domain in the hospital Incidentally, Dr Hipparigi Professor of Pharmacy KLE College of Pharmacy, Bangalore called on me last week and requested me to inaugurate a workshop on 'Community pharmacy' and also requested me to deliver a lecture on community pharmacy. This prompted me to advance my bog writing on community pharmacy which I wanted to upload after completing hospital pharmacy. The blog on community pharmacy I will upload part by part as the matter to be covered is so vast both in width and depth; Each sub-head in this blog needs an hour or two to complete the discussion under various parameters. Vision of Dr Abdul Kalam for 2020 ? Promotion of safe & effective rational medical use, patient counseling, monitoring disease management . ? To fill gap for the money spent by men & the full potential beneficiary results from economic, clinical, humanitarian perspective ? Preparing paramedics & technicians with quality training Community pharmacy is a place / establishment / institution where drugs are stocked for retail sale under valid license issued under Drugs & Cosmetics Act 1840. Though not exactly correct, the Chemists shops we find in the drugs market in India could be considered as community pharmacies. Well, I don't know how the term 'Chemists & Druggist' came into use for our medicine shops. The term 'Medicine shop' would have been more appropriate. Our law doesn't consider these chemist shops as 'Pharmacy' as the term carries a defined definition in the books of law. A place licensed for compounding and dispensing of formulations as per the prescription of a Registered Medical Practitioner is called 'Pharmacy'. The law issues the license to the retail trade under the caption; "License to sell or distribute the drugs ...." Hence, I strongly feel there is a need to amend the definition of 'Pharmacy' under the D& C Act and the caption of license under the Rules. Well now let us discuss rather briefly (considering the time limit I have) how to go about to establish a community pharmacy; 1. Decision ? First a formal decision should be taken on the desire to start a drugs business. ? Since community pharmacy ultimately is a trading activity with only about 20% technical input, the decision taken should be logical after considering alternates in the trading sector. ? When an organization or an individual takes a formal decision to start a community pharmacy it should consider and evaluate the following issues before proceeding ahead with the project; 2. S W O T analysis; It is an analysis of; - Strength; assessment and consolidation of strength available within. - Weakness; Honest confession and assessment of strength and weighing it against the strength. - Opportunity; Cursory evaluation of opportunities available and to be explored - Threat; Set backs due to market recession and competition [I suggest to all teachers to demonstrate SWOT analysis to their students] 3. Location - Location should be very carefully and cautiously considered. - A wrong decision at this level will ruin the business venture. - Area survey (Pre-market survey) should be carried out for; o Population density, o Doctors population, o Potential prescription sources, o Average foot-falls (Morning, Afternoon, Evening and night) in the located premises, o Average economic status of the population and their taste and life style, o Parking facility, o Safety and convenience for women, children and aged o Approachability for the vendors vehicles etc.. 4. Manpower; Appointment and posting of Qualified Registered pharmacist, shop-helpers, defining authorities with scope and limitations, appointment of auditors etc.. Defining and assigning of the job responsibilities of each category of staff and Key responsibilities for evaluation, 5. Infrastructure; Furniture for receiving stocks, storage as per storage specifications required, Installation of equipment including computer systems with broadband connectivity and LAN wherever necessary, Display shelves with shelf-talkers for OTCs, lighting system provision that is aesthetic and pleasing, good ventilation system, temperature and humidity regulating system, 6. Establishment; Obtaining the drug license 7. Business promotion; a. Marketing: - Pre-market survey; o Assessment of market potential, short listing of category of items that could be on demand. o Strategy to promote overall business and specific category to a better level, evolving schemes and devices to attract foot-falls o Ways and means to convert maximum number of visitors into buying customers b. Merchandizing; - Marketing brings the people into the shop and merchandizing brings the visitors close to the product and tempts them to pick, read the label and feel. It involves; ? stocking and Display of items to tempt the visitors to pick, see and feel the product, ? Shelf-talkers to inform the customers on the price and offers ? Personal assistance to understand their needs and guide them to the right OTC product etc.. 8. Logistics; Supply chain management is a crucial process to ensure the needs of the customers are always met obviating scarcity and loss. It involves; a. Preparation of master list of needs, categorization, Codification of items prioritization and quantification b. Preparation of master list of vendors, item-wise vendors in the order of preference and codification of vendors c. Carrying out commercial discussion, negotiation to define supply and payment terms d. Establishing a sound procurement policy, SOP, and Stock management, goods retuning system and waste disposal e. Documentation of goods in and out movement preferably on computer system to ensure System generated billing with a back up for manual billing in case of failure of computer system. 9. Fund sourcing, management and accounting; A. Assessment of fund requirement for; ? Capital investment; a. Building b. Furniture; storage and display racks, gondolas c. Lighting, ventilation, Air conditioning system, boards d. Equipments - refrigerators, computers, printers, fax machine etc.. ? Working capital; e. Statutory payments, f. Salary and consultancy components, g. Merchandizes; Drugs, cosmetics, Food and Nutrition etc.. h. Contingencies i. Repairs and maintenance j. Business promotion activities B. Negotiation with banks / financiers for better bargain 10. Operation - Civil and electrical maintenance and developmental activities, overall supervision of staff performance and Public relations etc.. ? Auditing; - Stock audit; Study of stock dynamics, identification and disposal of dead loads, physical stock Vs book value etc Accounts audit: Auditing of accounting of revenue and expenditures and evaluation of expenditures Performance; Based on evaluation of key responsibilities assigned Quality audit; Quality of personal presentation, communication knowledge, skill, conversion into revenue gain, etc 11. Ethics & Professionalism; A. Persons having specialized knowledge, skill and who provide value added reliable service are called a professionals. - For example; Clinician, Nurse, physiotherapist, technicians in radiology and pathology, laboratory, Advocate, Painter, Carpenter, Cobbler, Taylor, Electrician, Mechanic, Plumber - are all called 'Professionals'. They are indispensable no others can be substituted to do their job. B. Likewise the pharmacist is also a 'Professional'. The law has recognized him as a 'Professional' to carry out sale or distribution of drugs. - But unfortunately the pharmacist has betrayed the people at both ends and has deliberately and knowingly allowed all and sundry to do his job even in his absence. - Hence, the society is unable to accept him as a professional in the way he is functioning now. C. Why the law recognizes him as a 'Professional' and restricts the privilege only to him? [The law is made by the people and when we say the law demand or enforces it means in a democracy the people are demanding and enforcing i. Drugs are very sensitive molecules and the formulations are much more sensitive to the environment. ii. They need to be handled, cared, distributed / dispensed with utmost care with due documentation and counseling so that they retain their consistency and potency till they are consumed. iii. The professional care-chain that starts at the manufacturing level should continue up to the patient's bed. D. Hence whether a person in the 'Garb of the pharmacist' likes or dislikes, there is no second opinion that professional service is required in the drugs management and dispensing and should be delivered in the interest of the patient. No choice is left to the person in the 'Garb of a pharmacist' to ignore his professional obligation. E. Any person who is incapable or doesn't want to serve as a 'Professional pharmacist' but wants to enjoy only the privileges of a 'Pharmacist' cannot exist as a pharmacist. Hence he should reform himself and change his mind set to fall in line otherwise he should 'quit'. Though it looks very harsh, it is good for the profession, to the clinicians and to the public. F. Who wants professional service? (in other words Who cares?) 1. Well, as on now neither the doctor nor the public know what kind of professional job could be expected at the chemist's counter, beyond selling of medicines prescribed or demanded. 2. They are ignorant of the need to receive only from a pharmacist or have resigned from the idea due to apathy of the pharmacist. 3. People's representatives demand from the Government to post a doctor, a nurse, a technician. But they never have demanded the posting of a pharmacist. This is because his hob has become 'Anybody-can-do' job. 4. This can be interpreted both optimistically and pessimistically like the case of a shoe market survey in an island; i. Optimism; There is a huge potential to provide professional service and the field is fertile. ii. Pessimism; There is neither demand from the doctor nor from the public. Hence it is futile to talk of professionalism. 5. If we are pessimistic, well there is no need for monopoly and lets close the show and open the door for any science graduate to carry out the trade. If done, this will be disastrous crime committed on the ignorant people. 6. Hence professional service is the need of the hour and I advocate whoever is pessimistic should quit the profession. 7. Professionalism is nothing but value addition to the job done. i. Picking a strip of tablet from the shelf and handing over to the client is 'Any body's' job. ii. But ensuring; a. Correct storage, b. Understanding the prescription, c. Checking the strength and dose d. Dispensing to the client with due information and instructions on storage, handling and dosage regimen and what side effect to expect and what to do in case of such an event, what activities / risks he should avoid etc - are value additions to the job that can be delivered only by the professional Pharmacist D. Therefore, whether it is demanded or not it is the bounden duty of the 'Pharmacist' to deliver Professional service, in the best interest of the clinicians and public. As a professional he should provide all round material and service support to the client. I will discuss "How to give professional outlook?" in my next blog. Thank you.